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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR-APPLICATION TO BE ACCEPTED Date: Permit Number: ` ��' )�` o' zz . Building Permit Application; - Auru - � Planning and Development Services PE[;, ill '1ItvC� Building'and Code Regulation Division 5t. Lucie COUnty, F,L 2300 Virginia Avenue,Fort Pierce-FL 34982 Phone: (772)-462-1553- Fax: (772)462-1578 C0rnmercial Residential PERMIT.APPLICATION FOR: -To-Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION .Address: /V< 1-0 , TwzdAw gnlz' Legal Description: C 1�f,4__A Property Tax ID'#: w'0ax, 000—/ Lot No. Site Plan Name: Block No. / Project Name: Old�7L' Setbacks Front Back: Right Side: Left Side:_ DETAILED;DESCRIPTION OW 'F ORK r. " P"ho CONSTRUCTION INFORMATION _ - E �� - Additional work tolege Orme under this permit-check a appy: X_HVAC 1 Gas Tank Gas Piping _Shutters a Windows/Doors,. Electric 0 Plumbing ]Sprinklers F1 Generator ., 1 Roof F Roof pitch Total Sq. Ft of Construction: S . Ft.of First Floor: Cost of Construction:$ �(/��i� Utilities: Sewer�Septic :Building Height: OUVIVER/LESSEE` ": f `CONTRACTOR` , <_ � x4 J , Na •e a? , :, Cf,. ` Name: , AddresCompany:`r r W Ce,;:, �al�'''' City: t4 6? ' �/^ State: Address: �, " lc Zip Code: dGi -Fax: City: r �� State: Phone N r3 JOS 9/ Zip Code:` � Fax• E-Mail: Phone No. _-33 5� Fill in fee simple Title Holder on next page(if different E-Mail:Ca1,'V/4-GS from the Owner listed above) State or County License: If value of construction is$2500 or more,a RECORDED Notice of commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION; DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable Name: Name: Address: Address: City: State: City: State' Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: XNot Applicable Name: Name: Address: 4 Address: City: City:' Zip,: Phone: Zip: Phone: OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has commenced prior to the issuance of a permit. St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure which is in conflict with any applicable Home Owners Association rules;bylaws or and covenants that may restrict or prohibit such structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply. In consideration of the granting of this requested permit,I do hereby agree that I will;in all respects,perform the work in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments. The following building permit applications are exempt from undergoing a full concurrency review:room additions, accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite before the first inspection. If you intend.to obtain financing, consult with lender or an attorney before commencingwork or recordingour Notice of Commencement. Signatu er/Lessee/Contractoras Agent for Owner Signature of C tractor/License Holder . STATE OF FLORIDA STATE OF FLORIDA COUNTY OF -B,( UJ041 — COUNTY OF The forgoing instrument was ackno ledged efore me The for oing instru ent was acl owledged before me this�day of A-.Lr!�c'ST,20� y this 7 day of fit 20LZby Name of person making statement Name of 6erson making statement Personally Known OR Produced Identification Personally Known � OR Produced Identification Type of Identification Type of Identification Produced -FL P ream )4 Ce4n S 2 12 /2-3 Produ (Signature of Notary P to ELIC nature of Notary u fp,FAaXe of FlorinI R:NAVLOR •.. STATE 0R10A :? �. Notary Public-State of Florida Commission No. Fh Commission No. •"e . Comdl)*'rF 202193 ICommrk A6299., • aye. Expires•101191202© +� My Comm:Expires.;un 15,2019. AF Bonded through Natlo Notary Assn: REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED �. DATE— COMPLETED Rev.8/2/17